Provider Demographics
NPI:1710290150
Name:GAITWAY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:GAITWAY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANGANO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:516-659-8252
Mailing Address - Street 1:35 EARL DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1708
Mailing Address - Country:US
Mailing Address - Phone:516-623-4769
Mailing Address - Fax:
Practice Address - Street 1:6 ARCADIA LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4437
Practice Address - Country:US
Practice Address - Phone:516-623-4769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025236-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty